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Early medical risks to language development in extremely preterm infants

Journal of Perinatology volume 45, pages 378–385 (2025)Cite this article

Subjects

Abstract

Objective

To study the mechanistic role of neonatal morbidities on language performance in extremely preterm (EP) infants.

Study design

We conducted secondary analyses on EP infants born at a single tertiary care center, investigating whether neonatal morbidities mediated associations between gestational age and language performance at 18–26 months corrected age.

Results

Infants born at 25–26 weeks (n = 298) outperformed those born at 22–24 weeks (n = 177) in expressive communication, receptive communication, composite language, and cognition. Retinopathy of prematurity (ROP), grade 2/3 bronchopulmonary dysplasia (BPD), and cognition partially explained gestational age effects on expressive and receptive communication. In the final sequential path models, infants born 22–24 weeks gestation were more likely to be diagnosed with grade 2/3 BPD, which was linked to diminished cognitive skills, and reduced language skills.

Conclusion

Families of EP infants born under 25 weeks or with ROP and/or grade 2/3 BPD should be counseled about higher language impairment risk and receive proactive intervention.

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Fig. 1: Mediating effects of neonatal morbidities on language skills.
Fig. 2: Sequential mediation analyses of language skills.

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Data availability

The dataset is available in NICHD DASH (https://dash.nichd.nih.gov/) from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the families who participated in the study and the research staff who helped with data collection.

Funding

Paige Nelson was supported by the National Institute of General Medical Science (Grant T32GM108540). The original data collection was funded by the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (UG1HD053109).

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Authors and Affiliations

  1. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA

    Paige M. Nelson, Francesca Scheiber & Ö. Ece Demir-Lira

  2. Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Heidi M. Harmon

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  1. Paige M. Nelson
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  2. Francesca Scheiber
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Contributions

PMN and HMH conceptualized and designed the study, guided the statistical analyses, drafted the initial manuscript, and revised subsequent drafts. HMH also oversaw and coordinated data collection. FS contributed to drafting the initial manuscript, and ÖED supported the statistical analyses. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Paige M. Nelson.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in accordance with the Declaration of Helsinki. The original data collection was reviewed and approved by the Institutional Review Board at the University of Iowa. For this study, the IRB determined that, due to the de-identified nature of the data, further IRB review was not necessary. Informed consent was obtained from all participants.

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Nelson, P.M., Scheiber, F., Demir-Lira, Ö.E. et al. Early medical risks to language development in extremely preterm infants. J Perinatol 45, 378–385 (2025). https://doi.org/10.1038/s41372-024-02191-z

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